Provider Demographics
NPI:1699747584
Name:ESTRERA, CLEMENTE SOLANTE JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLEMENTE
Middle Name:SOLANTE
Last Name:ESTRERA
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:12930 CHESDIN LANDING DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-3234
Mailing Address - Country:US
Mailing Address - Phone:804-590-3773
Mailing Address - Fax:804-590-3772
Practice Address - Street 1:HWDMC, 7TH ALBEMARLE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803
Practice Address - Country:US
Practice Address - Phone:804-525-7420
Practice Address - Fax:804-524-4828
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101027965207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101027965OtherSTATE MEDICAL LICENSE